Information Needed to Quote:

    Name

    ABN (If registered)

    Phone Number

    Email Address

    Event Date

    Start Time & Finish Time


    Event Address

    Type of Function

    Estimated Attendance

    If over 500 see ‘event insurance’ not small event.

    Dates Cover

    from:
    to:

    Event Information (Specific)

    Will the event(s) involve any of the following activities? (if so, may require some additional information)

    Use of aircraft, hovercraft, or watercraft?

    YesNo

    Use of motor vehicles?

    YesNo

    Car parking facilities?

    YesNo

    Amusement rides or animal rides?

    YesNo

    Fireworks or pyrotechnic displays?

    YesNo

    DJ/Live Music/Theatrical/Dance/Artist Performances?

    YesNo

    Camping facilities available to patrons?

    YesNo

    If you answered yes to any of the above, please describe the activities, including who is responsible and if they have their own public liability insurances in place:

    Sum Insured:

    Public Liability

    10,000,00020,000,000

    Other Information

    Will alcohol be served or sold at this event?

    YesNo

    Who will be responsible for security at this event?

    Will you be signing any contracts that contain hold harmless or indemnity agreements?

    YesNo

    Additional Information

    Has any insurer ever declined to insure you or declined to renew any of your insurances or imposed special terms and conditions?

    YesNo

    In the last 10 years, have you ever had any criminal convictions or been bankrupt?

    YesNo

    In the last 10 years, have you suffered any public liability claims or caused incidents that could give rise to a public liability claim?

    YesNo

    Have you previously been insured for liability?

    YesNo

    If you answered yes to any of the above, please provide details: